Results: PWV was reduced from 14,12 to 11,89 m/sec (change 2,23 m/sec, p-value 0.01)) by RDT whic... more Results: PWV was reduced from 14,12 to 11,89 m/sec (change 2,23 m/sec, p-value 0.01)) by RDT which was also accompanied by a reduction of SBP (from 162,6 to 130,4 mmHg, p-value 0.02). DBP (from 97,4 to 83,6 mmHg, p-value 0.04) and MBP (from 119,3 to 99,2 mmHg, p-value 0.03) with no signifi cant change in HR (from 78 to 72 bpm, p-value 0.74). Calculation of the percent differences showed the magnitude of the PWV reduction (23.7%) to be greater than that of SBP, DBP and MBP (18.7%.13,8% and 16.1%, respectively). The Pearson's correlation analysis did not demonstrate significant correlations between the change in PWV and changes in HR (r = 0.335, p = 0.345), SBP (r = 0.176, p = 0.626), DBP (r = 0.178, p = 0.623) or MBP (r = 0.192, p = 0.596). Conclusions: Bilateral RDT procedure produced an acute signifi cant decrease in PWV. There was also an acute signifi cant reduction of SBP, DBP and MBP which, however did not show a signifi cant relationship with the PWV changes. This suggests that improvement of arterial stiffness by RDT maybe at least in part BP independent possibly in relation to the reduction of the stiffening effect of the sympathetic activity on the arterial wall. If so, the acute decrease in PWV by RDT might represent a marker of the effi cacy of the RDT procedure.
Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical feature... more Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation. Objective: The purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives. Methods: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis. Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted. Results: We found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders. Conclusions: Our findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS-related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS.
Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS), but it is unclear wheth... more Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with continuous positive airway pressure (CPAP) can revert MS. Does OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters? The TREATOSA-MS is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS, and moderate/severe OSA (apnea-hypopnea index, [AHI] ≥15 events/h) to undergo therapeutic CPAP or nasal strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, blood pressure, glucose, and lipid profile. To control potential related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat) and endothelial function. One-hundred patients (79% men; age: 48±9 years; body mass index: 33±4 kg/m2; AHI: 58±29 events/h) completed the study (n=50 per group). The mean CPAP adherence was 5.5±1.5 h/night. After 6-months, most patients with OSA randomized to CPAP kept the MS diagnosis but the rate of MS reversibility was higher than observed in the placebo group (18% vs. 4%; OR: 5.27; 95% CI 1.27 to 35.86; p=0.04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin and leptin but promoted a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values). Despite the higher rate of MS reversibility after CPAP therapy as compared to placebo, most patients still have this diagnosis. The lack of significant/relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.
como um aspecto mobilizador e necessário para a mudança de comportamento e adesão ao tratamento p... more como um aspecto mobilizador e necessário para a mudança de comportamento e adesão ao tratamento proposto. Palavras-chave: hipertensão; educação de pacientes; estresse psicológico.
Background: Intralipid and heparin infusion results in increased blood pressure and autonomic abn... more Background: Intralipid and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. Objective: To evaluate insulin sensitivity and the impact of Intralipid and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in patients with the indeterminate form of Chagas’ disease. Methods: Twelve patients with the indeterminate form of Chagas’ disease and 12 healthy volunteers were evaluated. Results: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas’ group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change in plasma noradrenaline. The low-frequency component (LF) was similar and similarly increased in both groups. The high-frequency component (HF) was lower in the Chagas’ group. Conclusion: Patients with the indeterminate form of Chagas’ disease had increased sympathetic activity at baseline and impaired response to insulin. They also had a lower high-frequency component and impaired baroreflex sensitivity at baseline and during Intralipid and heparin infusion. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)
Objective: Arterial stiffness is characterized by a decrease in arterial distensibility, resultin... more Objective: Arterial stiffness is characterized by a decrease in arterial distensibility, resulting from the interaction between the extracellular matrix and cellular elements. Large and small arteries can be differently influenced by extrinsic factors, such as excessive sodium intake. This study aim to evaluate the impact of sodium restriction on large artery stiffness and distensibility of small arteries in young adults diagnosed with arterial hypertension. Methods: Randomized controlled clinical trial, including 20 hypertensive patients, aged between 30 and 59 years, followed up at the hypertension outpatient clinic of a tertiary hospital. Subjects were randomized into two groups: group 1 - low-sodium diet (2 g sodium/day); group 2 - usual diet. To analyze the stiffness and distensibility of the arteries, it was measured aortic pulse wave velocity by Complior®, elasticity of small arteries and vascular resistance by HDI®, and also through the measurement of metalloproteinase-9. For nutritional assessment it were considered blood glucose levels, 24-h urinary sodium, body mass index (BMI) and other anthropometric measurements. For nutritional intake we analized the 24-hour dietary recall. Results and Discussion: In comparison with group 2, it was observed a significant (p < 0.05) reduction in office blood pressure (p = 0,037) and pulse wave velocity (p = 0,010) in group 1 subjects. Also, in group 1 it occurred reduction in blood glucose levels, BMI, waist and neck circumference. Sodium intake was significantly reduced in group 1, taking into account 24 hs urinary sodium and evaluated by dietary recall. It is worth mentioning that excessive sodium intake linked to arterial hypertension causes a remodeling process, increased oxidative stress, inflammation and fibrosis of the arteries, contributing to arterial stiffness. Regarding the distensibility of small arteries, no significant differences were found between the two groups, but the intervention period and the number of individuals in the study should be taken into account, since these factors may have influenced the results. Conclusion: Sodium restriction for a short period of time promoted reduction of arterial stiffness, in parallel to reduction in obesity parameters and blood pressure in adults diagnosed with systemic arterial hypertension.
Educational interventions, including increased physical activity and control of hypertension, can... more Educational interventions, including increased physical activity and control of hypertension, can be effective and cost-effective strategies. OBJECTIVE: To evaluate the effects of an educational program on the control of blood pressure (BP), physical performance and quality of life (QOL) of hypertensive patients. MATERIALS AND METHODS: Non-randomized controlled intervention study with hypertensive adults, both genders, followed up on an outpatient basis. The multiprofessional program consisted of 12 meetings with guidance on CVD and lifestyle changes. The six-minute walk test (6MWT), the QL Minnesota and International Physical Activity Questionnaires (IPAQ) and BP measurements were applied. The paired Student t test or Wilcoxon and ANOVA tests were used for repeated measures. RESULTS: Twenty patients participated, 82% women, 62 ± 11 years old. There was a reduction in systolic (147.0 vs 126.0) and diastolic (85.0 vs 70.0) blood pressure, increased distance covered (458 ± 83 vs 499 ± 77 p <0.001), reduction in symptoms of fatigue (4 ± 3 vs 2 ± 3 p <0.001) and dyspnea (4 ± 2 vs 2 ± 2 p <0.05) on exertion and reference of higher PA level (sedentary 2 vs 0; irregularly active 12 vs 5; active 8 vs 11; very active 0 vs 4). Reduction in the score of all domains in QOL was significant: Physical (14.5 ± 11.7 vs 8.9 ± 9.9 p = 0.004); Emotional (8.4 ± 6.5 vs 5.3 ± 6.6 p = 0.004); Others (9.5 ± 8.5 vs 6.6 p <0.001); Total (32.5 ± 25.5 vs 19.7 ± 23.5 p <0.001). CONCLUSION: Educational programs involving increased physical activity are effective in controlling BP, increasing physical performance and improving QoL of hypertensive patients.
SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the conseque... more SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.
The relational strategies in group are to improve patient's BP (blood pressure) control and QoL (... more The relational strategies in group are to improve patient's BP (blood pressure) control and QoL (quality of life). Methods: Twenty-one hypertensive patients were randomized into two groups: group A (10 patients, age 67 ± 6 years, BMI (body mass index) 28.3 ± 6 kg/m 2) was applied relational strategies, with meetings every 15 days 8 meetings; group B (11 patients, age 58 ± 13 years, BMI 28.2 ± 3 kg/m 2) with meetings for group orientation every 40 days 3 meetings. The patients were monitored: at baseline (day 15) and at the end of the study (day 120), the BP was measured by auscultatory method and the QoL questionnaire (WHOQOL-BREF) was applied, and was submitted to the examination with ABPM (ambulatory blood pressure monitoring). Results: after 120 days there was a greater (p < 0.05) reduction in SBP (systolic blood pressure) in group A (37.8 ± 25 mmHg) than in group B (18 ± 9 mmHg), but DBP (diastolic blood pressure) decreased similarly in both groups (A, 15 ± 21 vs B, 13 ± 14 mmHg); the HR (heart rate) reduction was larger (p < 0.05) in group A (60.6 ± 8.9 bpm) than in group B (69.7 ± 10.7 bpm). There was a more significant BMI decrease (p < 0.01) in group A (27.8 ± 5 kg/m 2) than in group B (28.9 ± 4 kg/m 2). The observed correlations between physical domain and nightime DBP (at day 120) in ABPM were r =-0.712 (negative correlation, p = 0.003); between psychological domain and SBP sleep time (at day 120) in ABPM were r =-0.527 (negative correlation, p = 0.044); between environmental domain and daytime Δ HR in ABPM were r =-0.573 (negative correlation, p = 0.007). Conclusion: the health education program conducted through interpersonal relationships within groups provided better control of SBP and greater reduction in BMI.
Results: PWV was reduced from 14,12 to 11,89 m/sec (change 2,23 m/sec, p-value 0.01)) by RDT whic... more Results: PWV was reduced from 14,12 to 11,89 m/sec (change 2,23 m/sec, p-value 0.01)) by RDT which was also accompanied by a reduction of SBP (from 162,6 to 130,4 mmHg, p-value 0.02). DBP (from 97,4 to 83,6 mmHg, p-value 0.04) and MBP (from 119,3 to 99,2 mmHg, p-value 0.03) with no signifi cant change in HR (from 78 to 72 bpm, p-value 0.74). Calculation of the percent differences showed the magnitude of the PWV reduction (23.7%) to be greater than that of SBP, DBP and MBP (18.7%.13,8% and 16.1%, respectively). The Pearson's correlation analysis did not demonstrate significant correlations between the change in PWV and changes in HR (r = 0.335, p = 0.345), SBP (r = 0.176, p = 0.626), DBP (r = 0.178, p = 0.623) or MBP (r = 0.192, p = 0.596). Conclusions: Bilateral RDT procedure produced an acute signifi cant decrease in PWV. There was also an acute signifi cant reduction of SBP, DBP and MBP which, however did not show a signifi cant relationship with the PWV changes. This suggests that improvement of arterial stiffness by RDT maybe at least in part BP independent possibly in relation to the reduction of the stiffening effect of the sympathetic activity on the arterial wall. If so, the acute decrease in PWV by RDT might represent a marker of the effi cacy of the RDT procedure.
Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical feature... more Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation. Objective: The purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives. Methods: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis. Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted. Results: We found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders. Conclusions: Our findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS-related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS.
Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS), but it is unclear wheth... more Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with continuous positive airway pressure (CPAP) can revert MS. Does OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters? The TREATOSA-MS is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS, and moderate/severe OSA (apnea-hypopnea index, [AHI] ≥15 events/h) to undergo therapeutic CPAP or nasal strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, blood pressure, glucose, and lipid profile. To control potential related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat) and endothelial function. One-hundred patients (79% men; age: 48±9 years; body mass index: 33±4 kg/m2; AHI: 58±29 events/h) completed the study (n=50 per group). The mean CPAP adherence was 5.5±1.5 h/night. After 6-months, most patients with OSA randomized to CPAP kept the MS diagnosis but the rate of MS reversibility was higher than observed in the placebo group (18% vs. 4%; OR: 5.27; 95% CI 1.27 to 35.86; p=0.04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin and leptin but promoted a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values). Despite the higher rate of MS reversibility after CPAP therapy as compared to placebo, most patients still have this diagnosis. The lack of significant/relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.
como um aspecto mobilizador e necessário para a mudança de comportamento e adesão ao tratamento p... more como um aspecto mobilizador e necessário para a mudança de comportamento e adesão ao tratamento proposto. Palavras-chave: hipertensão; educação de pacientes; estresse psicológico.
Background: Intralipid and heparin infusion results in increased blood pressure and autonomic abn... more Background: Intralipid and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. Objective: To evaluate insulin sensitivity and the impact of Intralipid and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in patients with the indeterminate form of Chagas’ disease. Methods: Twelve patients with the indeterminate form of Chagas’ disease and 12 healthy volunteers were evaluated. Results: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas’ group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change in plasma noradrenaline. The low-frequency component (LF) was similar and similarly increased in both groups. The high-frequency component (HF) was lower in the Chagas’ group. Conclusion: Patients with the indeterminate form of Chagas’ disease had increased sympathetic activity at baseline and impaired response to insulin. They also had a lower high-frequency component and impaired baroreflex sensitivity at baseline and during Intralipid and heparin infusion. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)
Objective: Arterial stiffness is characterized by a decrease in arterial distensibility, resultin... more Objective: Arterial stiffness is characterized by a decrease in arterial distensibility, resulting from the interaction between the extracellular matrix and cellular elements. Large and small arteries can be differently influenced by extrinsic factors, such as excessive sodium intake. This study aim to evaluate the impact of sodium restriction on large artery stiffness and distensibility of small arteries in young adults diagnosed with arterial hypertension. Methods: Randomized controlled clinical trial, including 20 hypertensive patients, aged between 30 and 59 years, followed up at the hypertension outpatient clinic of a tertiary hospital. Subjects were randomized into two groups: group 1 - low-sodium diet (2 g sodium/day); group 2 - usual diet. To analyze the stiffness and distensibility of the arteries, it was measured aortic pulse wave velocity by Complior®, elasticity of small arteries and vascular resistance by HDI®, and also through the measurement of metalloproteinase-9. For nutritional assessment it were considered blood glucose levels, 24-h urinary sodium, body mass index (BMI) and other anthropometric measurements. For nutritional intake we analized the 24-hour dietary recall. Results and Discussion: In comparison with group 2, it was observed a significant (p &lt; 0.05) reduction in office blood pressure (p = 0,037) and pulse wave velocity (p = 0,010) in group 1 subjects. Also, in group 1 it occurred reduction in blood glucose levels, BMI, waist and neck circumference. Sodium intake was significantly reduced in group 1, taking into account 24 hs urinary sodium and evaluated by dietary recall. It is worth mentioning that excessive sodium intake linked to arterial hypertension causes a remodeling process, increased oxidative stress, inflammation and fibrosis of the arteries, contributing to arterial stiffness. Regarding the distensibility of small arteries, no significant differences were found between the two groups, but the intervention period and the number of individuals in the study should be taken into account, since these factors may have influenced the results. Conclusion: Sodium restriction for a short period of time promoted reduction of arterial stiffness, in parallel to reduction in obesity parameters and blood pressure in adults diagnosed with systemic arterial hypertension.
Educational interventions, including increased physical activity and control of hypertension, can... more Educational interventions, including increased physical activity and control of hypertension, can be effective and cost-effective strategies. OBJECTIVE: To evaluate the effects of an educational program on the control of blood pressure (BP), physical performance and quality of life (QOL) of hypertensive patients. MATERIALS AND METHODS: Non-randomized controlled intervention study with hypertensive adults, both genders, followed up on an outpatient basis. The multiprofessional program consisted of 12 meetings with guidance on CVD and lifestyle changes. The six-minute walk test (6MWT), the QL Minnesota and International Physical Activity Questionnaires (IPAQ) and BP measurements were applied. The paired Student t test or Wilcoxon and ANOVA tests were used for repeated measures. RESULTS: Twenty patients participated, 82% women, 62 ± 11 years old. There was a reduction in systolic (147.0 vs 126.0) and diastolic (85.0 vs 70.0) blood pressure, increased distance covered (458 ± 83 vs 499 ± 77 p <0.001), reduction in symptoms of fatigue (4 ± 3 vs 2 ± 3 p <0.001) and dyspnea (4 ± 2 vs 2 ± 2 p <0.05) on exertion and reference of higher PA level (sedentary 2 vs 0; irregularly active 12 vs 5; active 8 vs 11; very active 0 vs 4). Reduction in the score of all domains in QOL was significant: Physical (14.5 ± 11.7 vs 8.9 ± 9.9 p = 0.004); Emotional (8.4 ± 6.5 vs 5.3 ± 6.6 p = 0.004); Others (9.5 ± 8.5 vs 6.6 p <0.001); Total (32.5 ± 25.5 vs 19.7 ± 23.5 p <0.001). CONCLUSION: Educational programs involving increased physical activity are effective in controlling BP, increasing physical performance and improving QoL of hypertensive patients.
SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the conseque... more SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.
The relational strategies in group are to improve patient's BP (blood pressure) control and QoL (... more The relational strategies in group are to improve patient's BP (blood pressure) control and QoL (quality of life). Methods: Twenty-one hypertensive patients were randomized into two groups: group A (10 patients, age 67 ± 6 years, BMI (body mass index) 28.3 ± 6 kg/m 2) was applied relational strategies, with meetings every 15 days 8 meetings; group B (11 patients, age 58 ± 13 years, BMI 28.2 ± 3 kg/m 2) with meetings for group orientation every 40 days 3 meetings. The patients were monitored: at baseline (day 15) and at the end of the study (day 120), the BP was measured by auscultatory method and the QoL questionnaire (WHOQOL-BREF) was applied, and was submitted to the examination with ABPM (ambulatory blood pressure monitoring). Results: after 120 days there was a greater (p < 0.05) reduction in SBP (systolic blood pressure) in group A (37.8 ± 25 mmHg) than in group B (18 ± 9 mmHg), but DBP (diastolic blood pressure) decreased similarly in both groups (A, 15 ± 21 vs B, 13 ± 14 mmHg); the HR (heart rate) reduction was larger (p < 0.05) in group A (60.6 ± 8.9 bpm) than in group B (69.7 ± 10.7 bpm). There was a more significant BMI decrease (p < 0.01) in group A (27.8 ± 5 kg/m 2) than in group B (28.9 ± 4 kg/m 2). The observed correlations between physical domain and nightime DBP (at day 120) in ABPM were r =-0.712 (negative correlation, p = 0.003); between psychological domain and SBP sleep time (at day 120) in ABPM were r =-0.527 (negative correlation, p = 0.044); between environmental domain and daytime Δ HR in ABPM were r =-0.573 (negative correlation, p = 0.007). Conclusion: the health education program conducted through interpersonal relationships within groups provided better control of SBP and greater reduction in BMI.
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